scholarly journals Relationship between doctors and patients in the end of life process in palliative care and dysthanasia

2021 ◽  
Vol 18 (1) ◽  
pp. 193-205
Author(s):  
Cynthia De Freitas Melo ◽  
Maria Rannielly de Araujo Lima Magalhães ◽  
Liza Maria Studart de Meneses ◽  
Railda Sabino Fernandes Alves ◽  
Ana Cristina Eberhardt Lins ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Point Of View ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Life Process ◽  
Patients With Cancer ◽  
Therapeutic Choice ◽  
Probabilistic Sample ◽  
Descriptive Survey

Introduction: In the course of an illness, when the patient receives a poor prognosis, he can be assisted with dysthanasia or palliative care. The therapeutic choice and the adherence to it are related, among other factors, to the quality of the doctor-patient relationship. The objective of this study was to evaluate the patients’ point of view of the doctor-patient relationship in the end of life process, and compare scores between patients in palliative care and those experiencing dysthanasia. Method: The design was a descriptive survey with a non-probabilistic sample composed of 234 patients with cancer in the end of life process: 117 in palliative care and 117 expriencing dysthanasia. Two instruments were used: a biodemographic questionnaire and the Questionnaire for Assessing the Doctor-Patient Relationship in the End of Life Process, and data were analyzed using descriptive and bivariate statistics in the Statistical Package for the Social Sciences software. Results: The results showed good evaluations of the doctor-patient relationship. Palliative care patients attributed better scores in terms of time dedicated, attention, confidence, understanding and communication; and patients experiencing dysthanasia made better assessments in terms of frequency of visits and continuity of care. Conclusion: It is concluded that this study represents an advance in studies on the subject and indicates that patients in palliative care perceive the doctor-patient relationship more positively than patients undergoing dysthanasia. It stressed that it is necessary to invest in training medical students and professionals to carry out interventions that prioritize the use of their oldest, simplest and most powerful technology: the relationship between professionals and patients.

scholarly journals Perceived Proximity and Distance in the Doctors-Patients Relationships : Application to the Breast Cancer Treatment Case

K@iros ◽  
2019 ◽  
Author(s):  
Patrick RALET ◽  
◽  
Pascal BRASSIER ◽  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Breast Cancer Treatment ◽  
Point Of View ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Treatment Pathway ◽  
The Relationship

An obvious questioning of the doctor-patient relationship leads us to conduct a research on the point of view of patients who have had to follow a breast cancer treatment pathway. We want to know to what extent the notions of distance/proximity make it possible to explain the doctors-patients relationships, and on what realities it is based. It appears that the answer is complex, multifaceted, and rather poses the question of the dimensions of the relationship alongside the medical protocol.

Pulmonary referrals to specialist palliative medicine: a survey

2021 ◽  
pp. bmjspcare-2021-003386
Author(s):  
Michael Bonares ◽  
Kenneth Mah ◽  
David Christiansen ◽  
John Granton ◽  
Andrea Weiss ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Chronic Respiratory Disease ◽  
Life Care ◽  
Care Needs ◽  
Patients With Cancer ◽  
Referral Criteria ◽  
Referral Practices ◽  
Palliative Care Needs

ObjectivesPatients with chronic respiratory disease have significant palliative care needs, but low utilisation of specialist palliative care (SPC) services. Decreased access to SPC results in unmet palliative care needs among this patient population. We sought to determine the referral practices to SPC among respirologists in Canada.MethodsRespirologists across Canada were invited to participate in a survey about their referral practices to SPC. Associations between referral practices and demographic, professional and attitudinal factors were analysed using regression analyses.ResultsThe response rate was 64.7% (438/677). Fifty-nine per cent of respondents believed that their patients have negative perceptions of palliative care and 39% were more likely to refer to SPC earlier if it was renamed supportive care. While only 2.7% never referred to SPC, referral was late in 52.6% of referring physicians. Lower frequency of referral was associated with equating palliative care to end-of-life care (p<0.001), male sex of respirologist (p=0.019), not knowing referral criteria of SPC services (p=0.015) and agreement that SPC services prioritise patients with cancer (p=0.025); higher referral frequency was associated with satisfaction with SPC services (p=0.001). Late referral was associated with equating palliative care to end-of-life care (p<0.001) and agreement that SPC services prioritise patients with cancer (p=0.013).ConclusionsPossible barriers to respirologists’ timely SPC referral include misperceptions about palliative care, lack of awareness of referral criteria and the belief that SPC services prioritise patients with cancer. Future studies should confirm these barriers and evaluate the effectiveness of strategies to overcome them.

Association of Palliative Care Consultation With Reducing Inpatient Chemotherapy Use in Elderly Patients With Cancer in Japan: Analysis Using a Nationwide Administrative Database

2016 ◽  
Vol 34 (7) ◽  
pp. 685-691 ◽  
Author(s):  
Motoko Sano ◽  
Kiyohide Fushimi
Keyword(s):  
Palliative Care ◽  
Elderly Patients ◽  
End Of Life ◽  
Hospital Setting ◽  
Geriatric Oncology ◽  
National Database ◽  
Patients With Cancer ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
The Impact

Background: The administration of chemotherapy at the end of life is considered an aggressive life-prolonging treatment. The use of unnecessarily aggressive therapy in elderly patients at the end of life is an important health-care concern. Objective: To explore the impact of palliative care consultation (PCC) on chemotherapy use in geriatric oncology inpatients in Japan by analyzing data from a national database. Methods: We conducted a multicenter cohort study of patients aged ≥65 years, registered in the Japan National Administrative Healthcare Database, who died with advanced (stage ≥3) lung, stomach, colorectal, liver, or breast cancer while hospitalized between April 2010 and March 2013. The relationship between PCC and chemotherapy use in the last 2 weeks of life was analyzed using χ2 and logistic regression analyses. Results: We included 26 012 patients in this analysis. The mean age was 75.74 ± 6.40 years, 68.1% were men, 81.8% had recurrent cancer, 29.5% had lung cancer, and 29.5% had stomach cancer. Of these, 3134 (12%) received PCC. Among individuals who received PCC, chemotherapy was administered to 46 patients (1.5%) and was not administered to 3088 patients (98.5%). Among those not receiving PCC, chemotherapy was administered to 909 patients (4%) and was not administered to the remaining 21 978 patients (96%; odds ratio [OR], 0.35; 95% confidence interval, 0.26-0.48). The OR of chemotherapy use was higher in men, young–old, and patients with primary cancer. Conclusion: Palliative care consultation was associated with less chemotherapy use in elderly Japanese patients with cancer who died in the hospital setting.

Beliefs about medicines, doctor-patient relationship, and coping among European patients with cancer

2016 ◽  
Vol 26 (2) ◽  
pp. 282-285 ◽  
Author(s):  
Luigi Grassi ◽  
Elena Meggiolaro ◽  
Maria Alejandra Berardi ◽  
Agustina Sirgo ◽  
Maria Cristina Colistro ◽  
...  
Keyword(s):  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Patients With Cancer ◽  
Beliefs About Medicines ◽  
And Coping

scholarly journals Qualitative Analysis of Palliative Care for Pediatric Patients With Cancer at Bugando Medical Center: An Evaluation of Barriers to Providing End-of-Life Care in a Resource-Limited Setting

2018 ◽  
pp. 1-10 ◽  
Author(s):  
B. Emily Esmaili ◽  
Kearsley A. Stewart ◽  
Nestory A. Masalu ◽  
Kristin M. Schroeder
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Pediatric Patients ◽  
Developing World ◽  
Participant Observation ◽  
Medical Center ◽  
Life Care ◽  
Patients With Cancer ◽  
Bugando Medical

Purpose Palliative care remains an urgent, neglected need in the developing world. Global disparities in end-of-life care for children, such as those with advanced cancers, result from barriers that are complex and largely unstudied. This study describes these barriers at Bugando Medical Center, one of three consultant hospitals in Tanzania, to identify areas for palliative care development suitable to this context. Methods In-depth interviews were conducted with 20 caregivers of pediatric patients with cancer and 14 hospital staff involved in pediatric end-of-life care. This was combined with 1 month of participant observation through direct clinical care of terminally ill pediatric patients. Results Data from interviews as well as participant observation revealed several barriers to palliative care: financial, infrastructure, knowledge and cultural (including perceptions of pediatric pain), and communication challenges. Although this study focused on barriers, what also emerged were the unique advantages of end-of-life care in this setting, including community cohesiveness and strong faith background. Conclusion This study provides a unique but focused description of barriers to palliative care common in a low-resource setting, extending beyond resource needs. This multidisciplinary qualitative approach combined interviews with participant observation, providing a deeper understanding of the logistical and cultural challenges in this setting. This new understanding will inform the design of more effective—and more appropriate—palliative care policies for young patients with cancer in the developing world.

End-of-life care in cancer and dementia: a nationwide population-based study of palliative care policy changes

2019 ◽  
pp. bmjspcare-2019-001782 ◽  
Author(s):  
Lou-Ching Kuo ◽  
Jung Jae Lee ◽  
Denise Shuk Ting Cheung ◽  
Ping-Jen Chen ◽  
Chia-Chin Lin
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Population Based ◽  
Life Care ◽  
Population Based Study ◽  
Patients With Cancer ◽  
Insurance Programme ◽  
National Health Insurance Programme ◽  
Vasopressor Use

ObjectivesThe National Health Insurance programme started providing coverage for inpatient care in palliative care (PC) units of acute care hospitals in 2000; however, initially, only PC provided to patients with terminal cancer was covered. A PC policy that enabled PC reimbursement for patients with dementia was implemented in 2009. However, the association of this PC policy with end-of-life care remains unclear. The study aims to compare the association of the PC policy with end-of-life care between patients with dementia and patients with cancer during the last 6 months of their lives.MethodsWe analysed the claims data of 7396 patients dying with dementia (PDD) and 24 319 patients dying with cancer (PDC) during 1997–2013.ResultsAmong PDC, while the percentage of receiving PC increased from 3.6% in 1999 to 14.2% by the end of 2000 (adjusted OR (aOR)=4.07, 95% CI 2.70 to 6.13) and from 20.9% in 2010 to 41.0% in 2013 (aOR=1.40, 95% CI 1.33 to 1.47), vasopressor use decreased from 71.6% in 1999 to 35.5% in 2001 (aOR=0.90, 95% CI 0.82 to 0.98). Among PDD, PC use increased from 0.2% in 2009 to 4.9% in 2013 (aOR=2.05, 95% CI 1.60 to 2.63) and cardiopulmonary resuscitation use decreased from 17.6% in 2009 to 10.0% in 2013 (aOR=0.83, 95% CI 0.76 to 0.90).ConclusionsImplementation of the PC policy in Taiwan was associated with improved PC utilisation among patients with cancer and dementia, which may reduce unnecessary medical care procedures.

Patterns of palliative care utilization and end of life care in adult patients with cancer who died as inpatients at Mayo Clinic.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. e21681-e21681
Author(s):  
Collin Thomas Zimmerman ◽  
Shivani S. Shinde ◽  
Pashtoon Murtaza Kasi ◽  
Mark Robert Litzow ◽  
Jeanne M. Huddleston
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Mayo Clinic ◽  
End Of Life Care ◽  
Adult Patients ◽  
Care Utilization ◽  
Life Care ◽  
Patients With Cancer
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